URTI Cases Flashcards
SB is a 47yo man who presents to the clinic for sore throat. Physical observation shows swollen lymph nodes in his throat, but has no tonsillar exudate nor cough. His temperature is 37.0ºC. He is otherwise healthy. He is allergic to penicillin (hives).
Diagnosis: Pharyngitis
What treatment plan would you recommend this patient? Include the dose and treatment duration.
No need Abx. Modified Centor criteria is 1 point, hence it is safe to presume viral pharyngitis. Consider supportive care: - PO Paracetamol 1g QDS - Topical analgesic lozenges/spray - Saltwater gargle - Adequate Fluid and rest
WP is a 13yo male who is complaining of sore throat. Physical observation shows swollen lymph nodes in his throat and tonsillar exudate. He says that he is not experiencing any cough. His temperature is 36.4ºC. He is otherwise healthy. He has NKDA.
Diagnosis: Pharyngitis
What treatment plan would you recommend this patient? Include the dose and treatment duration.
PO Penicillin VK 250mg QDS for 10 days
Start Abx because modified centor criteria is 4 point, which implies a high risk for bacteria pharyngitis
PK is a 18yo female who complains of sore throat. Her temperature is 38.2ºC. Her tonsils are swollen with secretions. She is not experiencing any cough. She experiences mild rash when taking penicillin.
Diagnosis: Pharyngitis
What Abx treatment plan would you recommend for this patient?
PO Cephalexin 250mg QDS (suitable for mild rash)
OR one of the following:
- PO Clindamycin 300mg TDS
- PO Clarithromycin 250mg BD
Meow is a 27yo female who complains of runny nose. She says that she cannot smell her favourite fish-and-chips since 2 days ago. Her nasal discharge is non-purulent. She does not feel any pain on her face, ears or throat. She says she is not coughing, but feels tired all the time ever since her runny nose started. Her temperature is 37.1ºC. The doctor suggested to start Ciprofloxacin 500mg BD
Diagnosis: Sinusitis
Do you agree with the doctor? Why or why not? If you disagree, recommend a treatment plan for this patient
Disagree with doctor because:
- Symptoms suggest viral sinusitis (1 major, 1 minor), hence no need to start Abx.
- S.pneumoniae has high resistance against cipro.
Recommend supportive care:
- Analgesics
- Saline irrigation
- Expectorant like guaifenesin
- Decongestants (not recommended)
Kitty is a 5yo boy who presents with runny nose. Kitty’s mother says that her son has been sneezing and coughing 5 days ago and he keeps rubbing his face. His mucus has yellowish-green substances . His temperature is 38.2ºC. He has NKDA
Diagnosis: Sinusitis
Weight: 20kg
What treatment plan would you recommend for this patient
PO Amoxicillin 800 - 900mg BD for 10 - 14d
note, high dose amoxicillin is used in sinusitis. For pediatrics, dose is 80-90mg/kg/day divided BD
Boop is a 29yo female who presents with runny nose. She said that she has been experiencing discharge and face pain 5 days ago, which got better. However, her symptoms suddenly returned today. She has purulent nasal discharge and she is unable to smell her favourite pork chop. Her temperature is 38.3ºC. She has NKDA.
Diagnosis: Sinusitis
Your junior pharmacist recommends PO Amoxicillin/clavulanate 1g BD for 5 days. Do you agree with the him? If not, suggest a treatment plan for this patient.
Presence of bacterial sinusitis: Very likely due to double sickening
Disagree with junior pharmacist because Amox/clav only used to cover H.influenzae if patient has recent course of abx, recent hospitalisation, or has failed to improve after 72h of amoxicillin. For this patient, amox/clav will be too overkill
Recommend: PO Amoxicillin 1g TDS for 5-10d
Doink is a 32yo male who presents with purulent runny nose. He mentioned that he visited the doctor a week ago for his runny nose. The doctor prescribed him PO Amoxicillin 1g TDS. However, his symptoms has not improved. He mentions that he had been dutifully taking his amoxicillin. His temperature is 38.1ºC. He has NKDA
Diagnosis: Sinusitis
Recommend a modification to the treatment plan for this patient if appropriate.
Failure to improve after 72h of amoxicillin is an indication for B-lacamase producing H.influenzae coverage.
Modification:
- Stop Amoxicillin
- Start PO Augmentin 625mg TDS for 5-10d
Woofy is a 22yo female who presents with runny nose. She say her symptom started 2 days ago. Her mucus is yellowish-green in colour and she feels pressure exerted on her face. She is also coughing and feels tired all the time. Her temperature is 39.0ºC. She has severe allergy to penicillins.
Diagnosis: Sinusitis
Recommend a treatment plan for this patient
≥2 major sx and high fever, suggesting presence of bacterial sinusitis
Recommend: PO Levofloxacin 500mg OD
PH is a Father who brought his 5-month old son to the clinic. He says that his son has been crying non-stop and has been tugging his left ear. Physical observation shows that there is no discharge in any of the ears. The son’s temperature is 36.5ºC. NKDA, 5kg.
Diagnosis: Acute Otitis Media
What treatment plan would you recommend to PH’s son?
Son’s age < 6 months: Observation period not recommended. Start Abx
PO Amoxicillin 200-250mg BD for 10d
(<2yo: Treat 10d
Dose: 80-90mg/kg/day PO divided BD)
MH is a Mother who brought her 2yo son to the clinic. She said that her son started rubbing both his ears 3 days ago. She also mentioned that she thought the ear rubbing would stop in a few days, but it did not, which led her to bring him to the clinic. Physical observation shows no discharge in any of the ears. Her son has no history of AOM and has no recent infection. NKDA, 37.9ºC, 8kg.
Diagnosis: AOM
Recommend treatment plan to MH’s son.
2yo, bilateral AOM without otorrhea: Patient is candidate for observation period, but observation is done. Hence, initiate abx.
PO Amoxicillin 320 - 360mg BD for 7d
(Treatment duration 7d as son is 2yo and has non-severe symptoms)
VK is a Father who brought his 18 month-old daughter to the clinic. He said that her daughter has been rubbing both her ears since yesterday. Physical examination show absence discharge in her ears. From the NEHR, his daughter was prescribed amoxicillin 3 weeks ago for pharyngitis and has completed the course. Her temperature is 37.6ºC. She weigh 6kg. NKDA
Diagnosis: AOM
Recommend a treatment plan to VK’s daughter
1yo, Bilateral AOM without Otorrhea: Start Abx immediately
Daughter used Amoxicillin in last 30 days for pharyngitis: There is indication to cover B-lactamase producing H.influenzae
Treatment: PO Augmentin 240 - 270mg BD for 10d
AZ is a Mother who brought her 7yo daughter to the clinic. Her daughter has been complaining of ear pain since today morning. Physical observation with an otoscope shows discharge in the ear with bulging and erythematous tympanic membrane. Her eyes are also red with pus. Her temperature is 39.2ºC and she has NKDA. She is 21kg
Diagnosis: AOM
Recommend a treatment plan to AZ for her daughter’s condition.
Eyes red with pus: Suspected purulent conjunctivitis, hence S.aureus coverage is indicated.
Treatment: PO Augmentin 840 - 945mg BD for 10d
Treat 10d due to high fever
QQ is a Father who brought his 6yo son to the clinic. His son is having a fever of 38.7ºC. QQ mentioned that his son has been complaining of ear pain 2 days ago and had several episodes of crying due to the pain. Physical examination shows discharge in both ears with swollen tympanic membrane. His son is allergic to penicillin (rash). He weighs 18kg
Recommend treatment plan for QQ”s son
Start Abx immediately due to otorrhea
Treatment: PO Cefuroxime 270mg BD for 10d
Cefuroxime is suitable for mild penicillin allergy. Dose is 30mg/kg/day divided to BD
Treat for 10d due to severe ear pain that lasted ≥48h (severe sx)
QQ is a 36yo healthy male who lives with his 87yo Mother, 86yo Father and his 35yo wife. His father is a transplant patient and his mother has HTN and Diabetes. Yesterday, his cousin’s family visited his household. Today, he was informed by his cousin that his niece is diagnosed with influenza.
Given that QQ’s whole family which includes himself received Influenza vaccine 2 months ago, state who should receive Influenza chemoprophylaxis. State the drug, dosing regimen and duration of chemoprophylaxis if needed. All of QQ family have NKDA
Case: Post-exposure prophylaxis
QQ and his wife: No need chemoprophylaxis as they are not high risk
QQ’s parents both need chemoprophylaxis as they are considered high risk (due to age + comorbidities)
Regimen: PO Oseltamivir 75mg OD for 7d
HW is a 32yo healthy mother who is diagnosed with influenza. She lives with her 36yo husband who is healthy and her 4yo daughter who is also healthy.
HW’s family, including himself, received influenza vaccine 3 months ago. All have NKDA.
Recommend a treatment plan for HW. Also state whether any of her family members require chemoprophylaxis
Case: Post-exposure prophylaxis
For HW: PO Oseltamivir 75mg BD 5d (treatment, not prophylaxis)
HW’s Husband: Chemoprophylaxis not required
HW’s daughter: Chemoprophylaxis NEEDED (age 4 is <5 hence high risk for influenza-related complication)
